LCA 25-26 Registration Form

2025-2026 School Year Registration
Lakeland Christian Academy
Registration Checklist

Please complete the information in this form to help us prepare for a great 2025-2026 school year! In order to complete this form, you will want to have the following items ready:
- list of emergency contacts and phone numbers
- physician information
- images of each child's insurance cards
- completed copies/scans of the Medication Orders and Consent Form (if applicable)
- most recent Immunization Records (for preschool, K, & 7th grade students; or an exemption affadavit)
- child's IEP/504, if applicable
- each child's shirt size
Visit lakelandchristian.org/forms to find printable versions of all forms that may be needed.
list of emergency contacts and phone numbersphysician informationimages of each child's insurance cardscompleted copies/scans of the Medication Orders and Consent Form (if applicable)most recent Immunization Records (for preschool, K, & 7th grade students; or an exemption affadavit)IEPs and/or 504s, if applicableeach child's shirt size
Parent Information
Father's Name

First NameLast Name
Father's Email Address
Father's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mother's Name

First NameLast Name
Mother's Email
example@example.com
Mother's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Payment Plan Selection

Tuition is an annual fee. Payment plan options include paying in full (annually), semester payments (bi-annually), monthly, and bi-monthly. Please consider and select the payment plan you would like set up for this school year.
Pay in Full (3% discount, due May 23, 2025)Semester Payments (due July 1, 2025 & December 1, 2025)11 monthly payments (June-May except Feb)9 monthly payments (Aug-May except Feb)
If you have any special considerations regarding payment plans, please describe those here.

Authorized Check-out Persons

The information entered below will be used to verify and update your child(ren)'s authorized check out list. This list will apply to all children recorded on this form.
Is there anyone you would like to remove from your child(ren)'s check out list? If so, please list their names here.
Is there any legal documentation restricting student release to certain persons? If so, please describe.
If applicable, please upload legal documents pertinent to student release/check out.

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Authorized Check-out Person #1
Name*

First NameLast Name
Phone Number*
Format: (000) 000-0000.
Email*
example@example.com
Relationship to Student*
Authorized Check-out Person #2
Name

First NameLast Name
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Relationship to Student*
Authorized Check-out Person #3
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Relationship to Student*
If you would like to add more than 3 people to your child's check out list, please reach out to the school office.

Field Trip Forms
As the parent/guardian of the child(ren) named in this form and by this instrument I do hereby release, bequit, hold harmless, and forever discharge Lakeland Christian Academy, Lakeland Baptist Church, their agents, servants, and employees, and all persons, natural or corporate, in privity with them or any of them from any and all claims or causes of action of any kind whatsoever, including, but not limited to actions, suits and/or claims for any bodily injuries, death, or property damage which may be sustained by my child(ren) while participating in any activity described here, including travel to and from such activities, not resulting from the intentional tortious act or acts of any agent, servant or employee of Lakeland Christian Academy or Lakeland Baptist Church. It is acknowledged that the decision to engage in the stated activities is entered into freely, and that Lakeland Christian Academy, Lakeland Baptist Church, their agents, servants, and employees have not influenced the decision to engage in such activities.
Signature*
Physician and Medical Information
Physician Name*

First NameLast Name
Physician Phone Number*
Format: (000) 000-0000.
Physician Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred Hospital
YesNo
Please upload a photo of the FRONT of the child(ren)'s insurance card(s).

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Please upload a photo of the BACK of the child(ren)'s insurance card(s).

Cancelof

Click the button below to submit.

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Parent Pledge